Healthcare Provider Details

I. General information

NPI: 1225966427
Provider Name (Legal Business Name): JEFFREY LANG LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5485 CONESTOGA CT STE 100H
BOULDER CO
80301-2752
US

IV. Provider business mailing address

5485 CONESTOGA CT STE 100H
BOULDER CO
80301-2752
US

V. Phone/Fax

Practice location:
  • Phone: 720-773-1364
  • Fax:
Mailing address:
  • Phone: 720-773-1364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0017372
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: